- Polycystic ovary syndrome (PCOS) is a disorder that affects 5% to 10% of women and is one of the most common causes of irregular periods and female infertility.
- Polycystic ovary syndrome is caused by irregularities in the reproductive hormones that can cause cysts to form on the ovaries, which hinder the development of healthy eggs and disrupt ovulation.
- Symptoms can vary significantly in women, and in addition to infertility may include irregular, prolonged or no menstruation, as well as acne, weight gain, an increase of facial hair, hair loss on the scalp, skin tags, and darkening of the skin in certain areas.
- PCOS is diagnosed if two of these three conditions are present (assuming other conditions that mimic the disease have been ruled out): persistent lack of ovulation, chronically high levels of testosterone, and ovaries with a number of small cysts (polycystic ovaries) containing eggs.
- The disease cannot be cured, but lifestyle changes, medicine and fertility treatments, such as intrauterine insemination (IUI) and in vitro fertilization (IVF), can help manage symptoms and improve fertility.
What is PCOS?
Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder in women that causes elevated levels of male hormones, such as testosterone, along with elevated luteinizing hormone and insulin levels. This causes the ovaries to not function normally, resulting in a woman’s eggs not developing properly and/or disrupting normal ovulation. PCOS can cause irregular or missed periods, which can lead to the development of cysts on the ovaries and infertility in women.
The cause of PCOS isn’t known. Some experts suspect a genetic issue that may be related to a malfunction in regulating the insulin hormone.
Polycystic ovary syndrome and infertility
Typically, a woman does not discover she has PCOS until she starts trying to get pregnant and cannot. Polycystic ovary syndrome affects up to 10% of women of child-bearing age. In fact, it is one of the most common causes of infertility in women, according to the Department of Health and Human Services. The disease interferes with ovulation and often causes cysts on one or both ovaries.
Women diagnosed with PCOS often do not ovulate properly to achieve a pregnancy, and they are at an increased risk of miscarriage if they do become pregnant. Risks in pregnancy and birth related to the syndrome include gestational diabetes, hypertension during pregnancy and pre-eclampsia.
Aside from infertility, there are other risks of polycystic ovary syndrome. The disruption of ovulation that PCOS causes can raise levels of estrogen that thickens the lining of the uterus and causes abnormal bleeding. It can also contribute to the development of endometrial polyps, hyperplasia and, ultimately, cancer. The syndrome and its symptoms also can cause depression and anxiety. Women with PCOS also have an increased lifetime risk of diabetes, obesity, high cholesterol and metabolic syndrome.
PCOS symptomsThe hormone problems with PCOS result in symptoms that affect different functions of the body including the menstrual cycle, dermatologic issues and metabolism. Often women with PCOS will experience different symptoms. Women with PCOS may experience some of the following symptoms:
- No menstrual period, irregular periods or periods occurring less frequently than normal.
- Type 2 diabetes.
- Excess facial and body hair (hirsutism).
- Male pattern baldness.
- Skin tags.
- Dark patches of skin.
Because there is no one test for the disease, a fertility specialist will perform a series of exams and evaluations to rule out other causes for polycystic ovary syndrome symptoms before diagnosing PCOS.
Steps to diagnosis include:
- Physical exam to assess thyroid, body mass index, blood pressure, waist size, hair on the body, acne and skin discoloration.
- Review of medical history to understand the patient’s history of menstrual irregularities and other infertility-related issues.
- Pelvic exam to look for abnormal physical indicators, such as an enlarged clitoris or swollen ovaries.
- Ultrasound (sonogram) to look for cysts on the ovaries and check the lining of the uterus.
- Blood tests to measure hormone levels, especially androgens (sometimes referred to as “male hormones”) such as testosterone, glucose, and indicators of health conditions other than PCOS.
- Chronically high levels of testosterone.
- Persistent lack of ovulation.
- Multiple cysts containing eggs on the ovaries.
The symptoms can be frustrating, but treatments that can help do so by managing the symptoms and also overcoming infertility induced by the condition. PCOS treatment often includes medicines, diet and lifestyle modifications, and clinical procedures. Whether the woman is trying to conceive or not has a determination on what treatment might be right for her.
For women who want to conceive, a specialist may suggest fertility treatments to work around the issue of PCOS. Often treatment can be as simple as using medication to help stimulate ovulation. Other times, it can include medication for ovulation along with intrauterine insemination (IUI) or, in some cases, in vitro fertilization (IVF) may be needed.
Lifestyle changes for PCOS
As with all fertility conditions, we often start with the least invasive treatments, including lifestyle changes the patient can make. Weight problems are frequently associated with polycystic ovary syndrome. In fact, PCOS symptoms tend to be more severe in women who are overweight or obese. Even as little as 5% weight loss can improve PCOS symptoms.
Exercise is often prescribed as a holistic treatment to minimize many of these conditions.
Medications for PCOS
If a woman suffers from polycystic ovary disease and does not want to get pregnant, the standard treatment is hormonal contraception (usually birth control pills, patch or vaginal ring). This treatment is proven to regulate periods, decrease excess hair growth and acne, and protect the lining of the uterus from abnormal cell growth that can cause irregular bleeding.
For women who want to become pregnant, we may use medications for PCOS such as hormone therapies.
Clomiphene citrate (Clomid brand name)
Clomiphene citrate (Clomid) is a common fertility treatment for women with PCOS. This fertility medication causes the ovaries to produce and release eggs.
Metformin is often used as an insulin-sensitizing drug to treat diabetes. However, it can also be used alone or with an ovulation inducing medication to improve or regulate ovulation. For women undergoing IVF, metformin, which decreases the amount of insulin levels (glucose) in the blood, might be used in combination.
Letrozole is an anti-androgen fertility medication, like clomiphene citrate, that helps the ovaries to produce and release eggs. Letrozole is as effective as clomiphene citrate at increasing ovulation although they work in different manners.
When a woman is taking one or more of the medications above, she should perform timed intercourse with her partner to achieve pregnancy.
If a patient does not get pregnant while using hormone-regulating medications alone, one of our PCOS specialists may prescribe gonadotropins. Gonadotropins are estrogen regulating hormones that are given as injections to cause ovulation. However, women who take these medications require frequent monitoring via blood tests and ultrasounds to see how their body is responding to treatment.
All PCOS medicine treatments pose risks, especially multiple gestation, and some may not be FDA-approved for treating infertility. One of our fertility specialists will be sure to discuss these issues with the woman before she takes any of these medications.
IUI and IVF for PCOS
The assisted reproductive technologies IUI and IVF can both help women with polycystic ovary syndrome become pregnant. While IVF generally has a greater success rate, our physician will discuss both options with the patient. Together they will consider medical condition, age and personal preferences to arrive at the best option for the individual.
IVF is an advanced fertility treatment that involves several steps. A woman begins by taking one or more of the fertility medications listed above and, when the time is right, her physician retrieves the eggs. Then an embryologist combines the eggs with sperm. Finally, the fertility specialist places one or two fertilized embryos into the patient’s uterus. With PCOS, we carefully manage the cycle to avoid ovarian hyperstimulation syndrome (OHSS).